1855 SAFETY AND EFFICACY OF EARLY UNCLAMPING DURING LAPAROSCOPIC AND ROBOTIC PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111855 SAFETY AND EFFICACY OF EARLY UNCLAMPING DURING LAPAROSCOPIC AND ROBOTIC PARTIAL NEPHRECTOMY Stephen Williams, Ravi Kacker, Jodi Machaber, and Andrew Wagner Stephen WilliamsStephen Williams Boston, MA More articles by this author , Ravi KackerRavi Kacker Boston, MA More articles by this author , Jodi MachaberJodi Machaber Boston, MA More articles by this author , and Andrew WagnerAndrew Wagner Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1902AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Early unclamping of the renal hilum has been shown to drastically reduce warm ischemia time during laparoscopic partial nephrectomy. We present a single surgeon series of laparoscopic partial nephrectomy (LPN) and robotic partial nephrectomy (RPN) including both traditional hilar clamping and an early unclamping technique. METHODS Using an IRB- approved prospective kidney surgery database, we identified 59 and 27 patients who underwent LPN and RPN respectively between November 2006 through October 2010. Preoperative characteristics and perioperative outcomes were analyzed. RESULTS There was no difference between the LPN and RPN cohort in terms of gender (p=0.62), age (p=0.68), operative side (p=1.00), American Society of Anesthesiology score (ASA, p=0.57) or preoperative estimated glomerular filtration rate (eGFR, p=0.27). There were nonsignificant trends towards increased BMI (mean 28.9 kg.m2 vs 27.2, p=0.06) and larger tumor size (mean 3.08 cm vs 2.47 cm, 0.084) in the LPN cohort. An early unclamping (EU) technique was used for 22 (81%) patients in the RPN cohort and 6 (10%) patients in the LPN cohort. (p=0.0001). Warm ischemia time was lower in the RPN cohort (mean 18.5 min vs. 28.0, p=<0.0001) as result of majority undergoing EU. There was no difference in OR time (p=0.28), estimated blood loss (p=0.38), length of stay (p=0.41), transfusion rate (p=0.55), positive surgical margin (p=0.42) or postoperative decrease in eGFR (22.9% LPN vs 14.0% RPN; p=0.14). There was no difference in mean eGFR decrease after early unclamping (16.1%) versus traditional clamping (22.1%, p=0.34). 11 (28.9%) patients had a greater than 50% decrease in eGFR after traditional clamping versus 0 patients after early unclamping (p=0.014). CONCLUSIONS In this single surgeon series, RPN with an early unclamping was a safe technique with similar perioperative outcomes as LPN. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e744 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Williams Boston, MA More articles by this author Ravi Kacker Boston, MA More articles by this author Jodi Machaber Boston, MA More articles by this author Andrew Wagner Boston, MA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...